Severe operational stress

I feel shredded. I was fuelled by anger on Friday, an anger I could not fully express to the equally upset staff at the hospital who are powerless to do anything about the situation we are all in.

I’d become dehydrated and felt dreadful as I’d had nil by mouth since 10pm on the previous evening, and my op was finally cancelled at 1215. I ran straight into the Spotlight interview fuelled by a pint of water and cheese and biscuits that I could barely swallow.

After the interview came a kind of emotional entropy that led to the sucking presence of a black hole. Chaos in my head as I wondered what to do, how I’d get through another weekend. Had I known the op was off before I’d got there, had I not met my new friend and been hit by her dreadful predicament, I’d perhaps have been able to prepare for it, plan some treats. I couldn’t cry even. And still no dreams, a kind of blank.

Yesterday (Saturday) I woke as usual at 3am, and read through Facebook. I couldn’t access my writing brain at all. I could barely stand in the morning; a weird internal tremble, a fine quavering drizzled from the point on my neck which marks the base of Hunt’s physiological and psychological presence. I laid down and managed to doze for a while after breakfast. I’m playing music, and have latched on to Adele’s new album, and an old Anthony and the Johnsons’, both of which connect emotionally and seem to calm me, but without blasting through my feigned equilibrium.

Plum and her daughter and I walked slowly on the moors to Wistman’s Wood in the spring sunshine in the afternoon, before retiring to the Two Bridges for a cream tea. It was lovely to see them, and to be outdoors, to chat with a ten-year old. I had a couple of wobbles but stayed upright, all through the slightly blurred vision that lends a kind of 1980s US soap flashback atmosphere where Bobby Ewing emerges from the shower having been apparently dead for the last two series…

Today (Sunday) Bun and I went to Plymouth’s Barbican and the Hoe with a couple of paramedic friends and had a lovely lunch and a big catch up. Of course the topic turned to the bed situation at Derriford.

Our district hospitals, in common with their cancelled surgical patients, are all under severe operational stress. It’s a constant, especially over winter where illness is more prevalent both in the community, and in the staff.

One point became clear today as we discussed it. When a crisis hits, the hospital trust implements a system of alerts that trigger certain actions to alleviate the immediate problem. But that’s not what’s happening, because the problem cannot be alleviated by the measures available. Bottom line – high alert states are not sustainable as a matter of routine, because once implemented there is simply nothing more you can do to further relieve the pressure.

This state of affairs has been continuing for weeks and months at a time, on an annual basis. The trusts are almost all in financial deficit and missing targets and it’s worsening rapidly. So they are losing money with hundreds of operations cancelled, and with no way of addressing the fundamental causes of the crisis which, while varied and complex, come down in the end to not enough money in the NHS and not enough beds, and swingeing cuts to social care which compounds the situation.

(When the government says social care is down to councils to fund, they fund the councils and have cut their budgets by 35% since 2010. When they talk of billions in bail outs for councils, they are talking Tory councils only. In any case bail outs are too little, too late).

This document from the Royal Devon and Exeter Hosptial (RDE) shows exactly what kinds of pressures are placed onto the services – and the staff – and explains in detail exactly how the pressures arise and how little can be done to sustain this level of crisis management – because that’s what this is – crisis management, resulting in the failure of the core functions of the hospital and its inability to meet such vital patient services as cancer waiting times, another of Jeremy Hunt’s alleged concerns. And the money they do have for surgery and so on is going down the drain.

It’s worth noting here that RDE is smaller than Derriford which is also the major trauma centre. If anyone can point me to Derriford’s equivalent document I’d be most grateful.

One common excuse for such crises are high numbers of elderly living longer. So where, in an area where people come to retire into the vast new housing developments, the Macarthy and Stone type buildings, are the commensurate extra resources? Without some joined up thinking and long term planning, we are sunk. Our hospitals have been struggling for years with this race to build while we allow the whole system to lurch from crisis to crisis. When I worked in Torbay just a few years ago, it was routine to find five or six ambulance trolleys with patients queueing up in the ED corridor, waiting for cubicles to become free. That hospital was already overwhelmingly too small for the burgeoning population 15 years ago. At that time 65% of the Torbay population was over the age of 65. Many of those have no support network because they’ve left it behind for a dream. I met one woman, in her late 60s, whose husband had become ill shortly after their long-planned move to the seaside. I’d been sent on the car to assess, and as we waited for an ambulance to take him to hospital she told me their story. He was dying, and had been for the year the’d lived in their lovely home. She’d been stuck, unable to join the clubs she’d meant to join; she missed her friends from home and her family desperately, but hadn’t expected this to happen. She told me she’d decided to knock on her neighbour’s door, try to find a friend close by where she could pop in for a cuppa now and again. The neighbour opened the door: ” We don’t socialise” she said, and slammed it in her face.

And if it’s not the role of government to plan for this, to have a long-term strategy, then what is their role? Blaming the crisis on the elderly?

The NHS needs money, now. It needs beds and staff. Instead it has a Secretary of State in Jeremy Hunt who has busied himself with the white elephant of a completely uncosted, routine 24/7 NHS while he attacks and alientates the front line staff. Meanwhile the NHS truly 24/7 system, the one that picked me up, diagnosed and planned my urgent treatment so efficiently and compassionately, is unable to carry out its plan for me. It has the resources, for which it is paying; the expert staff and the theatres. Yet these cannot be used for the want of beds. The entire system, based on clinical priorities, has collapsed in a catastrophic haemorrhage of money and lives. My tumour continues to grow.

Hunt is cutting nursing bursaries when we have too few nurses. He is discouraging the mature nursing students with life experience and most likely preventing many of them from entering the profession because they won’t be able to afford it. Doctors are leaving in droves as he tries to force unsafe practices on them while the hospitals collapse.

Hospital trusts have to say this too. Look at the apologies and excuses. It’s not their fault. But for goodness’ sake tell it like it is for once, stop covering for this government which is letting us all down.

I am under severe operational stress. I’m on Black Alert. I woke at 2am, and I’m still here writing at 0622. What if I don’t hear today? What if it’s another week like the last two? I was warned.

8 thoughts on “Severe operational stress”

Hi Lynne, I am amazed that in your situation you are still able to think and write so eloquently. I know I would be crawling up the walls trying to escape myself. This all absolutely stinks doesn’t it? And you and hundreds of other patients who urgently need surgery are the victims of these pompous and deceitful politicians. Keep strong, you are better than them. I always believe that what goes round comes round and eventually will bite them in the arse. Much love to you. Gill xx

Thank you Gill. Afraid it’ll come back to bite them too late for the NHS. All I can do is keep highlighting the problem. It gives me a wider purpose which I need (was going to say like a hole in the head, which I also need!)

Medical News today: 14 of the UK’s most senior doctors have written a letter urging Osborne to put more funding into social care in his budget due soon.
Sending hugs over the airwaves to you. Ant to all others waiting. It’s a poor substitute for a post-op bed, a hug, but I’m sending it anyway.

Hi Jenefer, Helen passed on your message too.
I saw the letter which is one further boost for the cause.
The other issue is too few beds, also in need of immediate funding (and perhaps some more sensitive management of staff!)
Hope you’re ok xxx